Obsessive-Compulsive Personality Disorder (obsessive compulsive neurosis).
Obsessive compulsive personality disorder(OCPD) is a condition characterised by distressing and debilitating recurrent thought intrusion and repetitive unwanted actions,over which the patient has no apparent control,though he regards them to be unwanted,unacceptable and undesirable. OCPD’S classical clinical picture was given by sigmund freud in 1817.
Psycho-pathology of OCPD
Repression occurs because of repressed conflicts between moral standards and urges,who affect is shown in the form of symptoms as an act of substitutes.
Symbolisation-obsessive acts leads to compulsion which is considered to be act of symbolic significance. compulsion withdraws or abolishes possible effect of his impulses and guilt feelings,achieves distorted satisfaction,self-punishment or compensation. reduces intensity of anxiety.
- Predisposing causes
- Familial predisposition
- Rigid routine made by parents for their children.
premorbid personality is anankastic(obsessive)personality.
- OCPD is common in individuals with high I.Q.
- OCPD co-exist with disorders like anxiety neurosis,depression and schizophrenia.
- OCPD is common in adolescence and early adulthood.
- Recurrent,persistent thought,impulse or image that patient cannot get out of mind despite individual’s effort to resist it.
- Obsessional thoughts or ideas-repeated and intrusive words or phrases,which are usually upsetting to patients like violent,sexual and sinful subjects.
- Obsessional ruminations-repeated preoccupation or worry with subjects of complex kind like religious or philosophical,fear of disease contamination,simple decision to meet a friend short distance away brings on thoughts like the bus may not run or there might be danger travelling on road,or distance may be too long to walk,friend may not be at home,may be busy,or may not want to go out…etc.
- Obsessional doubts-repeated thoughts expressing uncertainty about previous actions like person before leaving house locks the door and leaves but then goes back to check if it is locked or not.
- Obsessional impulse-repeated urges to carry out dangerous,aggressive or socially embarrassing actions eg shouting obscenities in public place,injury others or self,stealing(kleptomania),excessive intake of alcohol(dipsomania).
- Obsessional phobias like fear of close places,heights.
- Obsessional impulses leading to anxiety and avoidance eg wants to stab someone with knife and consequently avoidance of knives and sharp instruments.
- Repetitive and seemingly purposeful actions(rituals) performed in stereotyped way.
Features-always related to obsessive thoughts accompanied by subjective sense that they must be carried out,with urge to resist.
Examples of compulsive acts(repeated actions done a number of times) like
- Checking the windows and doors are properly closed.
- Washing the utensils and household articles.
- Hand washing
- Frequent changing of clothes
- Counting money
- Most of the cases resolve within a year and remaining run chronic,fluctuating and relapsing course.
- When severe,it last for several years and is resistant to treatment.
- Associated with other disorders,disappears rapidly with resolution of these disorders.
- Supportive therapy
provides continuing hope to maintain his functional capacity,maintain his defence and strengths and promote his adaptation to everyday living. supportive therapy involves giving reassurance to tha patient by explaining and educating about his disorder.
- Patient is instructed not to carry out his rituals,initially there is rise in distress with persistence both rituals and distress diminishes.
- Demonstrating the patient what is required and what is not eg explaining to patient that wash hands when they are dirty and carry out other activities by not washing hands.
- Patient is thought to arrest thoughts by arranging sudden intrusion snapping elastic band or clicking of fingers.